What’s Really Needed to Improve Health Care with Electronic Records

The recent New York Times article on increased healthcare costs from electronic records (“Medicare Bills Rise as Records Turn Electronic”, 9/21/12) seems at first glance to be discouraging. Aren’t electronic medical records supposed to reduce healthcare costs?

On reflection, it’s really not surprising that as physicians adopt electronic records, reimbursements, which are currently based on the quality of documentation, are increasing. The improvements in that documentation resulting from electronic records naturally increase payments. Ultimately, we need to change the health care payment system from rewarding activity to rewarding good care. But how can we realistically do that unless comprehensive patient information is available to accurately assess whether the care provided is truly appropriate?

Imagine an aircraft maintenance system where individual planes are repaired in various airports around the country, but all the repair records remain where the work is done. No mechanic would have access to the complete repair history of any plane. Crazy, right? Yes, but very much analogous to how we handle health care records. Wherever you receive care, a record – be it paper or electronic – is left behind, and no doctor has ready access to your complete history. It’s no wonder that healthcare costs are so high and that there are so many avoidable medical errors and adverse events.

Just making all medical records electronic will not solve this problem. We also need to create a mechanism to aggregate all your scattered records into a complete whole when they are needed. Of course, this must be done in a way that protects patient privacy, and ensures that medical record access is only available with your permission.

A simple, but largely unexplored, solution to this problem is the community health record bank. Such a health record bank would provide each person with a free account where copies of all their health records would be deposited when they are created. All access to the medical records in each account would be controlled by the patient to protect privacy. A nonprofit patient-governed community organization would run the bank, and it would be paid for by new and innovative uses of your health information with your permission. For example, most people would gladly pay a few dollars a year so that their loved ones would immediately be notified if their health record bank account were accessed by emergency medical personnel – meaning that emergency care was being given.

How would this help reduce healthcare costs? The anticipated efficiencies and improvements from electronic records will not primarily come from making the existing silos of paper records electronic – rather, the savings will result from having comprehensive records for each patient available when and where needed. For example, how can unnecessary duplicate tests and procedures be avoided without access to all the records of each patient?

So why hasn’t this straightforward health record bank solution been implemented? The simplest explanation is a “failure of imagination.” In our current record system, when a provider finds out that there are needed records at another provider site, those records are requested and (hopefully) transmitted – albeit typically by fax. Much of the current work towards electronic “health information exchange” has been directed to automating this process. However, it is very difficult, complex, and expensive to assure complete patient records by instantly finding, retrieving and integrating them from the various locations where they exist (more on this in a future blog). And, to make matters worse, while the health record bank solution is good for everyone, none of the existing healthcare stakeholders can easily take on this responsibility because they would not readily be trusted to avoid using the information to gain an unfair competitive advantage. Finally, patients, who would benefit most, typically do not have an effective voice when these issues are considered.

So if we are to really get the benefits of electronic medical records, and take advantage of their significant potential to improve the quality and lower the cost of healthcare, we need to begin implementation of a solution that will really solve the problem — like health record banks. Comprehensive electronic health records are an essential prerequisite for controlling health care costs while ensuring quality. Of all those concerned about these issues, who will step in and provide the seed funding needed to solve this problem?

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on Friday, September 28th, 2012 at 2:00 pm and is filed under .
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